DA Form 5441-19. Evaluation of Clinical Privileges - Dietetics
DA Form 5441-19 is intended for the evaluation of clinical privileges for Dietitians. This form plays a vital role in assessing and establishing the qualifications and requested privileges for registered dietitians involved in providing nutritional assessments and recommendations.
The form comprises sections where the dietitian provides personal and professional details, including licenses, certifications, and qualifications specific to dietetics practice. It necessitates outlining the requested clinical privileges, covering areas such as dietary assessments, nutritional counseling, and dietary planning.
Key fields in this form include the dietitian's identification information, requested clinical privileges, and supporting documentation showcasing their expertise in nutritional assessments and dietary planning. Accurate completion of this form is crucial to ensure that the dietitian is granted privileges aligned with their proficiency in providing nutritional guidance.
Application Example: A registered dietitian joining a military medical facility would utilize DA Form 5441-19 to request clinical privileges. By accurately completing the form and providing necessary documentation, the dietitian's proficiency in dietary assessments and nutritional counseling is evaluated, enabling the medical facility to grant appropriate privileges.
No additional documents are explicitly mentioned as required for filling this form.
Related Form: DA Form 5441-16, 5441-18, 5441-2, and 5441-20 are related forms intended for different clinical privilege evaluation processes.